OCD and EMDR
OCD the pathway
My pathway into OCD therapy began in 2009
I began working with 4 young men, who had
been unemployable since leaving education
All 4 had been referred for therapy in the past,
however the form of therapy offered had failed them.
Treat with a standard protocol (EX/RP) Refer on
Identify other therapeutic modalities Be innovative
I originally turned to the phobia protocol
OCD often resembles a phobia
Now I think of OCD more in terms of TRAUMA
Allows a client to confront issues safely
One thing I discovered from research into
OCD was that the exposure and response prevention was often too much of a
I originally used two different protocols
1 based loosely around the phobia protocol
1 based around the phobia protocol with Video
Results Video playback0 5 10 15 20 25 30 35 40
week 2 week 14 week 25 week 60
Modified phobia protocol0 5 10 15 20 25 30 35 40
Week 2 week 14 week 25 week 60
Comparison0 5 10 15 20 25 30 35 40
week 2 week 14 week 25 week 60
James Robin Michael Alix
David Blore, Charles Burdett If it had not been for the EMDR community and
people like David and Charles I would never have thought about publishing my findings.
In the following OCD Protocol, targets are
desensitized in the following sequence, starting with the current triggers (OCD compulsions and
obsessions); followed by past related disturbing
memories (if any); and then by the future template (imagining successful future action). In the OCD
Video Playback Protocol, each current target is fully processed using a modified standard EMDR
Phase One: Client History.
As with standard EMDR, a full client history is
taken, providing the therapist with insight into the client’s issues. Identification of triggers is on
Phase Two: Preparation.
The client is prepared as in the standard EMDR
protocol with a calm place, and with the addition of an imaginable nurturing figure,
strength figure, or a protection figure if needed.
The stop signal is taught
Phase Three: Video playback
procedure on identified
The following procedure is used separately for
each trigger (i.e., each OCD event).
“Play the mental videotape of the circumstances
of this OCD event. When you begin to
experience anxiety similar to the anxiety that you experienced during the actual event, let me
The modified EMDR protocol for phase 3 is then
client asked to identify the various components.
These include: a representative image, an
emotion that accompanies the image, and the body location of the emotion. The SUD score can be taken to provide a reference. I tend to rely upon feedback from the client as to level of anxiety.
Phases Four and Five.
EMDR processing is conducted as per standard
EMDR procedures; until there is little or no
disturbance (SUD = 0 or 1). The body scan is not conducted until all triggers have been
Repeat Phases 3, 4, and 5 for Each OCD Event or
During the processing of the trigger events a
touchstone event often presents. Touchstone events should be acknowledged and saved for processing once all trigger events have been processed.
Past Disturbing Memories
Phases 3, 4, and 5
After all OCD triggers (i.e., all compulsions and
obsessions) have been fully processed, any related past disturbing incidents are assessed and processed as per phases 3, 4, and 5 of the standard EMDR protocol (Shapiro, 1995, 2001)
After all OCD triggers and all past disturbing
memories are fully processed, the future
template is installed as per Shapiro’s phobia protocol (Luber, 2009b, p. 173).
Phase 6: 7: 8
Phase 6: Body Scan.
Body scan is conducted as per standard EMDR
protocol after completion of phase 5.
Phase 7: Session Closure.
Each session is closed as per standard EMDR
Phase 8: Re-evaluation
At the start of each session, re-evaluation of
previous work is conducted as per standard EMDR procedures.
ECO trial (EMDR vs CBT in OCD
Obsessive Compulsive Disorder (OCD) is the 4th
most common mental health disorder.
OCD is in the top 10 most handicapping illness as
described by the World Health Organisation.
OCD in terms of loss of income and decreased
Cognitive Behavioural Therapy (CBT) is the only
well-established psychological treatment for OCD recommended by NICE Guidelines (NICE, 2005)
CBT for OCD (in the UK) comes in two forms;
Exposure and Response Prevention Therapy (ERPUK)
EX/RP. Most commonly used
Cognitive Restructuring Therapy (CT)
CBT is effective at reducing the intensity of OCD
symptoms for about 50 to 60% of patient's who complete treatment, when full remission of OCD symptoms (e.g. recovery is used as an index of improvement the efficacy drops to 25% (Fisher & Wells 2005)
Maher el al 2010 demonstrated within research
that EX/RP is less than appropriate or effective for around 50% of those treated.
This RCT will be a two year study by NHS Leeds
Primary Care Mental Health and IAPT Service.
Zoe Marsden and Jaime Delgadillo are the main
This will be the first RCT into the treatment of OCD